Endocrine Abstracts

Introduction: The most common cause of Cushing’s disease is ACTH secreting tumours of the pituitary gland. It is associated with high morbidity and mortality. Pasireotide, a potential therapy, has a unique, broad somatostatin-receptor–binding profile, with high binding affinity for somatostatin-receptor subtype 5.

Case report: We present the a 40-years-old man diagnosed in 2005 with Cushing’s Disease for which a left adrenalectomy was performed (pathology report: diffuse and nodular adenomatous hyperplasia). In January 2006 given the persistence of hypercortisolism and the adenomatous hyperplasia in the right adrenal gland (49/29 mm), surgery was performed on this location also. After surgery, evolution was not good, the signs and symptoms of Cushing’s Disease persisted, the urinary cortisol levels were very high and and for this Ketoconazole treatment (200 mg×3 per day) was initiated. Another surgery was performed on the left adrenal gland (CT showing a 1.5 cm nodule). Until 2008 the blood and urinary cortisol levels remain upper limit under Ketoconazole therapy. High ACTH and pituitary microadenoma require transsphenoidal surgery to practiced and which has proved to be ineffective. Another surgery is required which manages to normalize the ACTH and cortisol levels until 2012. Re-growth of ACTH requires begun the treatment with cyproheptadinum 4 mg (6/4 cp per day). When admitting of July 2014 ACTH and cortisol values are maintained above the limit: ACTH=177 pg/ml, Cortisol=15 μg/dl, UFC=1753 nmol per day, and the MRI showing the pituitary microadenoma. We decide to start the treatment with Pasireotide (0.6 mg×2 per day) with a 2 months follow up (in October) when ACTH and cortisol have been normalized.

Conclusions: In our patient’s case Pasireotide was the last and the only option, because the other proved inefficient in time. The significant decrease in cortisol levels in patients with Cushing’s disease who received pasireotide supports its potential use as a targeted treatment for corticotropin-secreting pituitary adenomas.